Giant pleomorphic adenoma of the parotid gland involving the parapharyngeal space treated by a totally extraoral transparotid approach

Panoussopoulos, Dimitris; Yotakis, J.; Pararas, B.; Theodoropoulos, George; Papadimitriou, Κonstantina

doi:10.1002/jso.10165

Cited by 6 publications

(10 citation statements)

References 9 publications

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“…Anatomically, the tumor more commonly involved the superficial lobe of the parotid gland ( n = 29, 70.7%) giving rise to the clinical presentation of a large preauricular mass. Nevertheless, when the deep lobe of parotid and parapharyngeal spaces were involved by the tumor, patients presented with an intraoral swelling leading to soft palate displacement, difficulty in swallowing and breathing, and obstructive sleep apnea [ 11 , 13 , 16 , 17 , 22 , 25 ]. While diagnosis was primarily based on clinical and radiographic (USG, CT, and MRI) findings, preoperative diagnosis was established through FNAC in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our literature review, giant PA involving the superficial lobe of parotid was managed either by SP or ECD [ 4 , 10 , 24 , 26 – 29 , 31 , 32 ]. On the contrary, TP was reportedly done for tumors exhibiting malignant characteristics [ 8 , 12 , 15 , 17 , 19 , 20 , 23 , 30 ] and those involving both the deep and superficial lobes [ 9 , 13 , 14 , 16 – 18 , 21 , 32 ] ( Table 1 ). Since the present case was that of a PA involving superficial parotid only (Figures 1 and 2 ), the patient was surgically managed through ECD ( Figure 3 ), avoiding any iatrogenic damage to the facial nerve ( Figure 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the present review, 9 cases of PA were reportedly involving the deep lobe of parotid and extending into pharyngeal spaces. The cervical-transparotid surgical approach was used for resection in 6 cases [ 11 , 13 , 16 , 17 , 22 ], a transcervical, split-mandibulotomy approach was used in 2 cases [ 17 , 25 ], and one case was managed through a transoral approach using “Double-Y” incision in soft palate [ 16 ] ( Table 1 ). Postoperative complications following surgical resection of parotid PA are similar to that of other benign SGT [ 1 , 4 , 7 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature

Alkindi

Ramalingam

Hakeem

et al. 2020

Case Reports in Dentistry

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Salivary gland tumors (SGT) comprise 3% of all head and neck tumors, are mostly benign, and arise frequently in the parotid gland. Pleomorphic adenoma (PA) is the commonest SGT, representing 60-70% of all benign parotid tumors. Clinically, parotid PA presents as irregular, lobulated, asymptomatic, slow-growing preauricular mass, involving both superficial and deep lobes, and could grow to gigantic proportions. Histologically, PA has epithelial and mesenchymal elements in chondromyxoid matrix and is managed surgically. Based on a review of 43 cases reported in English literature since 1995, giant parotid PA is reported as large as 35 cm (diameter) and 7.3 kg (resected weight). Although rare, 10 cases of malignant transformation were reported in the review. Surgical management included extracapsular dissection (ECD), superficial parotidectomy, and total parotidectomy for benign tumors, and adjuvant radiation or chemotherapy for malignant tumors. We further present the case of a 36-year-old healthy male with slow-growing and asymptomatic giant parotid PA, of 4-year duration. The patient presented with firm, lobulated preauricular swelling, provisionally diagnosed as PA based on radiographic and cytological findings. The tumor was resected through ECD, and the patient had uneventful postoperative recovery and a 7-year recurrence-free follow-up period. Histological examination revealed epimyoepithelial proliferation punctuated by chondromyxoid areas, with extensive squamous metaplasia and keratin cysts. To the best of knowledge from indexed literature, giant parotid PA is rarely reported in Saudi Arabia. In addition to its rarity, this case is reported for its benign nature despite atypical histological presentation, successful surgical management without complications, and long-term recurrence-free follow-up. Based on this report, clinicians must be aware of atypical histological presentations associated with PA and plan suitable surgical management and follow-up to avoid morbidity. Nevertheless, attempts must be made to diagnose and manage these lesions at an early stage and before they reach gigantic proportions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature

Alkindi

Ramalingam

Hakeem

et al. 2020

Case Reports in Dentistry

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“…Fear of surgery, lack of information, negligence, and other sociocultural factors have been identified as other reasons for late presentation. [5,6] Since the 1998 [4] review of the ten largest PAs ever published in the English-language literature, more recent reports [5][6][7][8][9][10][11][12] have documented lesions of various sizes often affecting the deep lobe of the parotid gland. The present case affecting only the superficial lobe of the left parotid gland weighs 5.5 kg and adds to scientific literature.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Giant PA is uncommon, few cases have been reported in the parotid gland (superficial and deep lobes) weighing a few kilograms and of considerable sizes and dimensions. [4][5][6][7][8][9][10][11][12] The present report adds to the scientific literature on giant PA of the parotid gland. We highlight the socioeconomic factors associated with the late presentation and challenges associated with surgical resection of a giant parotid mass.…”

Section: Introductionmentioning

confidence: 94%

Giant parotid pleomorphic adenoma in a Nigerian male

et al. 2016

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Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, accounting for up to 60% of all tumors of the salivary gland and 75-80% of all parotid tumors. It has a slow but progressive growth pattern and if untreated can become greatly enlarged in size. However, giant PA is uncommon. We report a case of giant parotid PA of more than 10 years duration in a 60-year-old male Nigerian. A 60-year-old male patient with 10-year history of painless, massive, and pedunculated swelling in the left side of lower face measuring 25 cm × 23 cm × 17 cm in dimension. Computerized tomographic scan and percutaneous fine needle aspiration cytology returned a preliminary diagnosis of PA. Superficial parotidectomy with facial nerve preservation via the transcervical approach was performed. The excised mass weighed 5.5 kg while the postoperative healing was satisfactory. Benign PAs may attain a giant size if left untreated. Socioeconomic problems are some of the reasons for late presentation. Adequate excision of the tumor sparing the facial nerve is possible but intraoperative and reactionary hemorrhage are likely complications.

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Margin status, local control, and disease‐specific survival in surgically resected parotid carcinomas with parapharyngeal extension

McGill

Putri

et al. 2021

Head & Neck

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Background Resection of parotid carcinomas involving the parapharyngeal space is challenging. How this affects tumor margin control, recurrence, and survival is unclear. Methods Patients who underwent resection of parotid carcinomas between 1985 and 2015 at Memorial Sloan Kettering Cancer Center were evaluated for the impact of parapharyngeal extension (PPE) on margin status, local recurrence‐free probability (LRFP), and disease‐specific survival (DSS). Results Out of 214 patients in whom preoperative imaging was available for review, 22 (10.3%) had PPE. Matched by histotypes, carcinomas with PPE had comparable margin positivity (p = 0.479), T classification (p = 0.316), pathologic risk (p = 0.936), and adjuvant therapy (p = 0.617) to those without PPE. The 3‐year LRFP was 88.9% versus 95.4% (hazard ratio [HR] 2.23 after adjusting for pT classification, p = 0.342) and the 5‐year DSS was 74.2% versus 69.5% (adjusted HR 0.45, p = 0.232) in patients with and without PPE. Conclusion PPE does not appear to worsen oncologic outcomes in the resection of parotid carcinomas.

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Giant pleomorphic adenoma of the parotid gland involving the parapharyngeal space treated by a totally extraoral transparotid approach

Cited by 6 publications

References 9 publications

Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature

Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature

Giant parotid pleomorphic adenoma in a Nigerian male

Margin status, local control, and disease‐specific survival in surgically resected parotid carcinomas with parapharyngeal extension

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